This latest issue of Practice Tips is on infection control and what it means to clean before you sterilize. According to CDC guidelines, in order for an item to be sterilized, it must first be "clean." What exactly does "clean" mean? The CDC classifies an item "free of gross debris" clean. That's it.
How Can You Clean Your Instruments?
First, consult the instructions provided with your instruments. Many of them have specific guidelines as to how to clean them or particular chemicals to avoid. In general, you should try to avoid harsh chemicals whenever possible, this includes all disinfectants. As long as you steriize the item in question (i.e. resistant to heat), NO NEED to disinfect. The only purpose of disinfection is to kill bacteria that may be present, if an item is NOT sterilized. Look at the chart from the ADA in regards to the levels of sterilizing and disinfecting:
Using Barriers
If an item cannot stand sterilization (item not made of materials that withstand heat, pressure, and moisture from sterilization) then it needs disinfection. However, it is still preferable to use the "barrier method" rather than disinfecting the item in question. That is, cover the item in plastic (pouches, film, or a similar disposable barrier).
Many plastic barriers biodegrade, but the harsh chemicals of the disinfectants are composed of are not, so disinfection isn't necessarily the most "green" process. More importantly, disinfectants shorten your instrument life and barriers help protect your equipment, as well as extend the life thereof. Prolonging the life of your equipment is not only environmentally sustainable, but it also saves your practice money.
Using a Machine to Clean
The CDC and OSHA both recommend using "mechanical means" to clean instruments whenever possible. Both the CDC and OSHA make this recommendation out of concern for the safety of staff. If a machine cleans an instruments ("…instrument washer, ultrasonic, washer disinfector, dish washer…" [page 73]), this reduces the handling of instrument, resulting in less injury to staff. The OSHA bloodborne pathogens standard also discusses the dangers of sharps injuries and should be consulted for further information on instrument handling.
Whatever method you use, make certain that your instruments are clean, dry, and free from debris before you sterilize. If using an ultrasonic cleaner, make certain to rinse any ultrasonic solution from your instruments as well as they can bake on during sterilization and cause damage to your instruments.
So remember, you need to clean BEFORE you sterilize, and disinfect only if you can't sterilize. Try to bag them, rather than disinfect, if possible. We hope you learned a little more about sterilization and disinfecting your dental instruments.
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